Scotland’s Futures Forum
Drug use and harm
Dr. David Shewan
Research Director
Glasgow Centre for the Study of Violence
Glasgow Caledonian University
Drug use and society
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Psychoactive drug use - including alcohol and tobacco is widespread within most societies.
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Problems associated with drug use, and particular
drugs, are primarily focused upon health and crime:
these can seriously and tragically affect the individual
user, family, friends, loved ones.
Drug problems can affect local communities, criminal
justice systems, health services, employment and
economic productivity; at a global level the illegal drug
trade can have a negative impact on entire countries.
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Drug Use and Society
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Most drug use is relatively nonproblematic, causing little harm to self
and/or others.
This involves a number of protective
factors, ranging from personal to
societal. A distinction, albeit not
straightforward, can be made between
‘controlled’ and ‘addicted’ use.
A Scottish newspaper, 14/7/07
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I OVERDOSED ON 14 CUPS OF ESPRESSO
DEALER'S BABY PLEA IS REJECTED
CRUEL DRUNK KILLED PUPPIES
TEETOTALLERS GET STONED
ROBIN WILLIAMS: BACK ON THE
WAGON
DESPERATE: SCOTLAND’S POOREST
KIDS
A Scottish newspaper, 17/06/06
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‘Homophobic thugs’ jailed for 28 years over murder
Two army psychiatric casualties every day in Iraq
Wife-killer dies in prison
Suspect charged in shooting incident
Boy held over woman’s death
Pub glass ban ‘could make drinking more dangerous’
Hunt after ‘sleeping girl’ seen locked in car boot
Girl, 3, targeted by paedophile in McDonalds
Domestic abuse helpline calls soaring
Same Scottish newspaper, same
day…
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Good response to appeal over schoolgirl attacks
Eight-year-old among 500 Scots children in drugs
rehab
Golden eagle found poisoned with banned pesticide bait
on Deeside
Youngest mother to be taken into care
Bomber hid explosive in his shoe
Slums spread as more people become city dwellers
Pentagon excludes press from Guantanamo
Snipers claim four more killings
Ship evacuated after bomb hoax
Wife’s severed head found at crash site
The relationship between risk, drug user, drug use,
and drug-related outcome is heterogeneous and
complex
Perceived risk
(User)
Drug
Physical harm
Dependence
Social (economic) harms
Enjoyment
Relaxation
Stimulation
The Medical Model of Substance
Addiction
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Assumes detrimental effects to the individual and
society.
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Assumes that drugs do things to people and make them
behave in certain ways.
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Psychological factors are seen as secondary, and social
and cultural factors are mainly just referred to.
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Treatment is usually necessary to stop further
deterioration.
Drug, Set, and Setting
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DRUG - the pharmacological action of the substance.
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SET - underlying and learned psychological aspects of
the user (and the influence of genetic and biological
characteristics).
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SETTING - situational factors, and the wider social
and cultural context.
Set
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Many problematic drug users also have (other)
mental health problems.
These could be underlying health problems,
they could be exacerbated by problematic drug
use, they may be the result of problematic drug
use.
There is strong and increasing evidence that
many problematic drug users are seriously
traumatised (c.f. The Barlinnie Project).
Can you pass the Acid Test…
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“On Becoming a Marijuana User” (Becker,
1963). Arguably one of the earlier modern day
examples of harm reduction advice:
To learn how to take the drug; to recognise
the effects; to interpret the effects as pleasant.
Becker also applied these principles to LSD
use in the 1960s.
As predicted, after an initial flurry of ‘novice’
LSD users entering hospital, these numbers
drastically reduced.
Set - in denial?
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A paper by Phillip Murphy, Liverpool John Moores
University presented data from 328 ecstasy users and
reported that ‘even’ after two years regular use most
still felt positive about the drug’s effects and wished to
keep using for this reason. His conclusion:
“It is likely that some users come to prefer the person
they are, and the world they experience, under the
influence of the drug. This may be seen as a form of
psychological dependence, even though they are not
physically addicted to it” (Quoted in The Observer,
2004).
At the top of the hierarchy of harmful
drugs of misuse… heroin.
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“The opiates are drugs of addiction… anyone
who takes an opiate for a long enough time
will become addicted.” (Edwards, 1984).
Although…
“People who use heroin are highly disposed to
having serious personal and social problems
before they touch heroin… heroin is a ‘worse’
drug only because ‘worse’ people use it.”
(Robins, et al. 1980, 2005).
At the top of the hierarchy of harmful
drugs of misuse… heroin.
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And it has been argued…
“Their [addicts’] heroin use is anything but an escape
from life. They are actively engaged in meaningful
activities seven days a week. They are always on the
move and must be alert, flexible and resourceful.”
(Preble and Casey, 1969).
“Some patterns of heroin use can be non-intrusive to
the user and society. A more integrative theoretical
understanding of drug use does not rest on
assumptions about the causal effect of simply taking a
particular drug [heroin]” (Shewan and Dalgarno,
2005).
Setting
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The Rat Park Experiments (Alexander, et al., 1994)
These involved creating an environment in which to carry out
these experiments which in an experimental psychology
context closely resembled as practically possible a ‘natural
environment’. As described by Alexander (1994):
“Rat Park, as it came to be known, was airy and spacious,
with about 200 times the square footage of a standard
laboratory cage. It was also scenic, (with a peaceful British
Columbia forest painted on the plywood walls), comfortable,
(with empty tins, wood scraps, and other desiderata strewn
about the floor), and sociable (with 16-20 rats of both sexes in
residence at once).” [p.24].
Setting
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“Nothing that we tried instilled a
strong appetite for morphine or
produced anything that looked
like addiction in rats that were
housed in a reasonably normal
environment.” [p.27].
Crack Babies
Long-term [American] research with crack
babies has indicated that these children are
impaired, however this impairment has little to
do with prenatal cocaine exposure and a lot to
do with social exclusion – most crack babies
have heard gunshots by age 7. Such findings
are unpopular for many obvious reasons –
poverty is harder to tackle, less easy and
popular to campaign against, than drug use
(Stanton Peele, website).
Shewan and Dalgarno, (2005) –
Controlled Heroin Use
Participants were recruited through social networks
and must have:
 Illicitly used opiates at least ten times in each of the
preceding two years.
 Never been in treatment for any drug (including
alcohol).
 Never served a custodial sentence.
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126 people living in Glasgow. 75% were male, 25%
female, the mean age was 28.5 years.
SES, Education, and the general population
Occupational status (I = highest)
SES category
I
II
III
IV
V
Heroin sample
9%
29% 53% 9%
0%
UK population
5%
23% 48% 18% 6%
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At the time of the study, levels of the population currently in
higher education in Scotland, was recorded at 47% of the
general population (Universities Scotland, 2001).
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There were no significant differences between the controlled
heroin use sample and the general population on either of
these variables – possibly the most important finding in the
study.
Opiate
Drug
heroin
codeine
opium
methadone
Ever
used
124
(98%)
101
(80%)
84
(67%)
69
(55%)
Average No.
days used last
two years
Mean – 167
Median - 50
Mode - 25
Mean - 28
Mode - 0
Mean - 7
Mode - 0
Mean - 31
Mode - 0
Mean
years
used
Mean age
first use
7
21
7.5
21
9
22
5
24
Non-opiate
Drug
Alcohol
n ever
used
126
(100%)
Cannabis
126
(100%)
Amphetamine
124
(98%)
Ecstasy
124
(98%)
Benzos
106
(84%)
Cocaine
122
(97%)
Crack
39
(31%)
Mean Mean
age amount
first used per
use
session
14
10 units
15
1.5g
17
2g
21
1.5 pills
19
3 pills
20
1g
25
1 rock
Cocaine
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65% of those who had used cocaine had used it
in the six months prior to interview
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The mean years of use for cocaine was 8 years
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52% of those who had used cocaine had used it
with opiates; the main reason being to ‘enhance
the effects’ of both drugs.
Availability and motivation
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84% of the sample reported that for them
heroin was ‘very easy’ or ‘easy’ for them
to obtain.
98% of the sample rated heroin as ‘very
enjoyable’ to use.
These questions weren’t asked about
cocaine, but…
Injecting and sharing
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25% had ever injected; 15% had injected within the two years
prior to interview.
Ongoing regular injecting was confined to 5% of the sample.
10% had ever shared injecting equipment; 3% had shared in
the two years prior to interview.
No participant had tested positive for HIV. One participant
had tested positive for hepatitis C.
Research outcomes
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At the conclusion of the study, 7% (6/85) of the
follow-up sample had entered specialist
treatment for their drug (heroin) use.
No participant had died.
No participant was serving a custodial
sentence.
One participant had gone to Amsterdam, had a
sex change operation (and seemed happy
enough).
Implications
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Drugs assumed to be addictive may not
necessarily be used in an addicted way (e.g.
heroin, cocaine).
Drugs assumed to be harmful may not be
necessarily so. Drugs assumed to drive
criminal behaviour may not necessarily do
so.
Researchers require to collect data from
‘hidden’ populations and not rest primarily
on assumptions about the causal effects of
simply taking a particular drug.
Drug, Set, and Setting
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Acknowledges the complexity of drug
use and addiction; provides a model
for comparing factors associated with
problematic versus non-problematic
drug use.
It is a valid framework to predict and
explain, for example, controlled
versus addicted heroin use.
A medical approach
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Can be overstated.
But, it can be argued, has a range of
practical values - an improvement in
treatment and interventions; more
sympathetic approach from family,
employers, the criminal justice system.
But does a focus on ‘drug’ help in this
respect?
Drug, set, and setting
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Acknowledges the complexity of drug use and
addiction.
Provides a model for comparing factors
associated with problematic versus nonproblematic use of particular drugs.
As a theory it requires appropriate sampling.
It is a useful framework to predict and
explain, for example, controlled heroin use.
Or, chaotic use of [name drug].
Visible harms, unobtrusive users
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Typically, controlled drug users have jobs, are
well-educated, and are law-abiding and
productive members of the community.
They also happen to use a lot of drugs,
including the most harmful. But as drug
users, they were indeed unobtrusive.
So, what would be the ethics of criminalising
this group because of their drug use? Would
this be the greater harm?
So what do you do…?
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Help people with problems, including their problems
with drug misuse; provide the full range of treatment
and care options.
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Education, prevention, harm reduction.
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Generally, leave people alone who seem okay, and don’t
have problems with the drugs they use.
From whatever angle, what use the Misuse of Drugs
Act?
The Delphic System
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Your expert views please, on…
Smoking it [heroin], right, you’ll maybe just get a
little buzz, but if you inject it then you’re ‘phewww
bingoed!’ So then, of course if they tried smoking
it and they’re not getting their hands on enough of
it, which they probably arenae, then they try
injecting it like ‘whoa what a difference!’, ken?.
So then they’re injecting it. Why? Because it
works better than smoking it. You understand
what I mean? [male prisoner].